Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland; Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland; Global Observatory for Palliative Care Institute for Culture and Society University of Navarra, Pamplona, Spain.
J Am Med Dir Assoc. 2022 Feb;23(2):297-303.e14. doi: 10.1016/j.jamda.2021.12.019. Epub 2021 Dec 30.
To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC).
A multistep expert consensus process.
Multinational and multidisciplinary experts in LTC and ageing.
The consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus.
The preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care.
An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.
就长期护理（LTC）干预措施达成共识，这些干预措施将纳入通过全民健康覆盖（UHC）提供的服务包中。
多步骤专家共识过程。
LTC 和老龄化方面的多国和多学科专家。
共识过程由 3 个阶段组成：（1）预咨询轮次，该轮次基于之前的范围审查生成的初步 LTC 干预措施清单；（2）2 轮调查，以就 LTC 的重要、可接受和可行干预措施达成共识；（3）小组会议以敲定共识。
预咨询轮次生成了 117 项干预措施的初始清单。在第 1 轮中，联系了 194 名专家，其中 92 名（47%）完成了调查。在第 2 轮中，邀请了参加第 1 轮的相同专家，其中 115 名（59%）完成了调查。在第 2 轮的 115 名受访者中，有 80 名参加了第 1 轮。来自不同学科（如老年病学家、家庭医生、护士、心理健康和康复专业人员）的专家参加了第 2 轮，代表了 42 个国家。在第 1 轮中，有 81 项干预措施达到了重要性的预定阈值，在第 2 轮中，有 41 项干预措施达到了可接受性和可行性的预定阈值。在第 1 轮和第 2 轮之间有 9 项存在冲突的干预措施在小组会议上进行了讨论。推荐的由 50 项干预措施组成的清单来自 6 个领域：无偿和有偿护理人员的支持和培训、以人为本的评估和护理计划、内在能力下降的预防和管理、功能能力的优化、需要重点关注的干预措施以及姑息治疗。
国际讨论和共识过程产生了 LTC 干预措施的最低清单，这些干预措施将纳入 UHC 的服务包中。该服务包将为在整个护理连续体上为需要长期护理的老年人提供更强大的综合服务框架的行动奠定基础。
